Kauer W K, Peters J H, DeMeester T R, Ireland A P, Bremner C G, Hagen J A
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Ann Surg. 1995 Oct;222(4):525-31; discussion 531-3. doi: 10.1097/00000658-199522240-00010.
The author's goal was to determine the role of duodenal components in the development of complications of gastroesophageal reflux disease.
There is a disturbing increase in the prevalence of complications, specifically the development of Barrett's esophagus among patients with gastroesophageal reflux disease. Earlier studies using pH monitoring and aspiration techniques have shown that increased esophageal exposure to fluid with a pH above 7, that is, of potential duodenal origin, may be an important factor in this phenomenon.
The presence of duodenal content in the esophagus was studied in 53 patients with gastroesophageal reflux disease confirmed by 24-hour pH monitoring. A portable spectrophotometer (Bilitec 2000, Synectics, Inc.) with a fiberoptic probe was used to measure intraluminal bilirubin as a marker for duodenal juice in the esophagus. Normal values for bilirubin monitoring were established for 25 healthy subjects. In a subgroup of 22 patients, a custom-made program was used to correlate simultaneous pH and bilirubin absorbance readings.
Fifty-eight percent of patients were found to have increased esophageal exposure to gastric and duodenal juices. The degree of mucosal damage increased when duodenal juice was refluxed into the esophagus, in that patients with Barrett's metaplasia (n = 27) had a significantly higher prevalence of abnormal esophageal bilirubin exposure than did those with erosive esophagitis (n = 10) or with no injury (n = 16). They also had a greater esophageal bilirubin exposure compared with patients without Barrett's changes, with or without esophagitis. The correlation of pH and bilirubin monitoring showed that the majority (87%) of esophageal bilirubin exposure occurred when the pH of the esophagus was between 4 and 7.
Reflux of duodenal juice in gastroesophageal reflux disease is more common than pH studies alone would suggest. The combined reflux of gastric and duodenal juices causes severe esophageal mucosal damage. The vast majority of duodenal reflux occurs at a pH range of 4 to 7, at which bile acids, the major component of duodenal juice, are capable of damaging the esophageal mucosa.
作者的目标是确定十二指肠成分在胃食管反流病并发症发生过程中的作用。
胃食管反流病患者并发症的患病率令人不安地增加，尤其是巴雷特食管的发生。早期使用pH监测和抽吸技术的研究表明，食管暴露于pH高于7的液体（即可能源自十二指肠）增加可能是这一现象的重要因素。
对53例经24小时pH监测确诊为胃食管反流病的患者研究食管中十二指肠内容物的存在情况。使用带有光纤探头的便携式分光光度计（Bilitec 2000，Synectics公司）测量腔内胆红素，作为食管中十二指肠液的标志物。为25名健康受试者确定了胆红素监测的正常值。在22例患者的亚组中，使用定制程序将同时的pH和胆红素吸光度读数进行关联。
发现58%的患者食管暴露于胃液和十二指肠液增加。当十二指肠液反流至食管时，黏膜损伤程度增加，即巴雷特化生患者（n = 27）食管胆红素异常暴露的患病率显著高于糜烂性食管炎患者（n = 10）或无损伤患者（n = 16）。与无巴雷特改变的患者相比，无论有无食管炎，他们的食管胆红素暴露也更多。pH与胆红素监测的相关性表明，大多数（87%）食管胆红素暴露发生在食管pH值为4至7之间时。
胃食管反流病中十二指肠液反流比单纯pH研究提示的更为常见。胃液和十二指肠液的联合反流会导致严重的食管黏膜损伤。绝大多数十二指肠反流发生在pH值为4至7的范围内，在此范围内，十二指肠液的主要成分胆汁酸能够损伤食管黏膜。
